Facilitating needs based cancer care for people with a chronic disease : evaluation of an intervention using a multi-centre interrupted time series design

Background: Palliative care should be provided according to the individual needs of the patient, caregiver and family, so that the type and level of care provided, as well as the setting in which it is delivered, are dependent on the complexity and severity of individual needs, rather than prognosis or diagnosis. This paper presents a study designed to assess the feasibility and efficacy of an intervention to assist in the allocation of palliative care resources according to need, within the context of a population of people with advanced cancer. ---------- Methods/design: People with advanced cancer and their caregivers completed bi-monthly telephone interviews over a period of up to 18 months to assess unmet needs, anxiety and depression, quality of life, satisfaction with care and service utilisation. The intervention, introduced after at least two baseline phone interviews, involved a) training medical, nursing and allied health professionals at each recruitment site on the use of the Palliative Care Needs Assessment Guidelines and the Needs Assessment Tool: Progressive Disease - Cancer (NAT: PD-C); b) health professionals completing the NAT: PD-C with participating patients approximately monthly for the rest of the study period. Changes in outcomes will be compared pre-and post-intervention.---------- Discussion: The study will determine whether the routine, systematic and regular use of the Guidelines and NAT: PD-C in a range of clinical settings is a feasible and effective strategy for facilitating the timely provision of needs based care.

Population-based survival estimates for childhood cancer in Australia during the period 1997–2006

Background: This study provides the latest available relative survival data for Australian childhood cancer patients. Methods: Data from the population-based Australian Paediatric Cancer Registry were used to describe relative survival outcomes using the period method for 11 903 children diagnosed with cancer between 1983 and 2006 and prevalent at any time between 1997 and 2006. Results: The overall relative survival was 90.4% after 1 year, 79.5% after 5 years and 74.7% after 20 years. Where information onstage at diagnosis was available (lymphomas, neuroblastoma, renal tumours and rhabdomyosarcomas), survival was significantly poorer for more-advanced stage. Survival was lower among infants compared with other children for those diagnosed with leukaemia, tumours of the central nervous system and renal tumours but higher for neuroblastoma. Recent improvements in overall childhood cancer survival over time are mainly because of improvements among leukaemia patients. Conclusion: The high and improving survival prognosis for children diagnosed with cancer in Australia is consistent with various international estimates. However, a 5-year survival estimate of 79% still means that many children who are diagnosed with cancer will die within 5 years, whereas others have long-term health morbidities and complications associated with their treatments. It is hoped that continued developments in treatment protocols will result in further improvements in survival.

Clinical outcomes in residential care : setting benchmarks for quality

Aim Australian residential aged care does not have a system of quality assessment related to clinical outcomes, or comprehensive quality benchmarking. The Residential Care Quality Assessment was developed to fill this gap; and this paper discusses the process by which preliminary benchmarks representing high and low quality were developed for it. Methods Data were collected from all residents (n = 498) of nine facilities. Numerator–denominator analysis of clinical outcomes occurred at a facility-level, with rank-ordered results circulated to an expert panel. The panel identified threshold scores to indicate excellent and questionable care quality, and refined these through Delphi process. Results Clinical outcomes varied both within and between facilities; agreed thresholds for excellent and poor outcomes were finalised after three Delphi rounds. Conclusion Use of the Residential Care Quality Assessment provides a concrete means of monitoring care quality and allows benchmarking across facilities; its regular use could contribute to improved care outcomes within residential aged care in Australia.

Prospective, non-randomized phase 2 clinical trial of carboplatin plus paclitaxel with sequential radical pelvic radiotherapy for uterine papillary serous carcinoma

Objective Uterine Papillary Serous Carcinoma (UPSC) is uncommon and accounts for less than 5% of all uterine cancers. Therefore the majority of evidence about the benefits of adjuvant treatment comes from retrospective case series. We conducted a prospective multi-centre non-randomized phase 2 clinical trial using four cycles of adjuvant paclitaxel plus carboplatin chemotherapy followed by pelvic radiotherapy, in order to evaluate the tolerability and safety of this approach. Methods This trial enrolled patients with newly diagnosed, previously untreated patients with stage 1b-4 (FIGO-1988) UPSC with a papillary serous component of at least 30%. Paclitaxel (175 mg/m2) and carboplatin (AUC 6) were administered on day 1 of each 3-week cycle for 4 cycles. Chemotherapy was followed by external beam radiotherapy to the whole pelvis (50.4 Gy over 5.5 weeks). Completion and toxicity of treatment (Common Toxicity Criteria, CTC) and quality of life measures were the primary outcome indicators. Results Twenty-nine of 31 patients completed treatment as planned. Dose reduction was needed in 9 patients (29%), treatment delay in 7 (23%), and treatment cessation in 2 patients (6.5%). Hematologic toxicity, grade 3 or 4 occurred in 19% (6/31) of patients. Patients' self-reported quality of life remained stable throughout treatment. Thirteen of the 29 patients with stages 1–3 disease (44.8%) recurred (average follow up 28.1 months, range 8–60 months). Conclusion This multimodal treatment is feasible, safe and tolerated reasonably well and would be suitable for use in multi-institutional prospective randomized clinical trials incorporating novel therapies in patients with UPSC.

Nursing and Midwifery Services Strategic Directions, 2011-2015

This document presents the newly updated strategic directions for strengthening nursing and midwifery services (SDNM) for the period 2011–2015. Complementing and building on the 2002–2008 SDNM, it seeks to provide policymakers, practitioners and other stakeholders at every level with a flexible framework for broad-based, collaborative action to enhance the capacity of nurses and midwives to contribute to: * universal coverage * people-centred health care * policies affecting their practice and working conditions, and the * scaling up of national health systems to meet global goals and targets. The SDNM for 2011–2015 draws on several key World Health Assembly resolutions, and are underpinned by the associated global policy recommendations and codes of practice. (1,2) After two years of extensive research and consultation, a SDNM task force was developed, and a consensus on a range of specific activities revolving around 13 objectives in five interrelated key results areas (KRAs), was achieved: n health system and service strengthening n policy and practice * education, training and career development * workforce management and * partnership. Stakeholders, although free to prioritize certain parts of the framework to meet their own particular needs, are encouraged to adhere to the cornerstone of collaborative action, namely the common goal enshrined in the core SDNM 2011–2015 vision statement: improved health outcomes for individuals, families and communities through the provision of competent, culturally sensitive, evidence-based nursing and midwifery services.

Defending the patch : a labour geography analysis of unions’ construction of and responses to the problem of declining union membership amongst youth

If the trade union movement is to remain an influential force in the industrial, economic and socio/political arenas of industrialised nations it is vital that its recruitment of young members improve dramatically. Australian union membership levels have declined markedly over the last three decades and youth union membership levels have decreased more than any age group. Currently around 10% of young workers aged between 16-24 years are members of unions in Australia compared to 26% of workers aged 45-58 (Oliver, 2008). This decline has occurred throughout the union movement, in all states and in almost all industries and occupations. This research, which consists of interviews with union organisers and union officials, draws on perspectives from the labour geography literature to explore how union personnel located in various places, spaces and scales construct the issue of declining youth union membership. It explores the scale of connections within the labour movement and the extent to which these connections are leveraged to address the problem of youth union membership decline. To offer the reader a sense of context and perspective, the thesis firstly outlines the historical development of the union movement. It also reviews the literature on youth membership decline. Labour geography offers a rich and apposite analytical tool for investigation of this area. The notion of ‘scale’ as a dynamic, interactive, constructed and reconstructed entity (Ellem, 2006) is an appropriate lens for viewing youth-union membership issues. In this non-linear view, scale is a relational element which interplays with space, place and the environment (Howett, in Marston, 2000) rather than being ‘sequential’ and hierarchical. Importantly, the thesis investigates the notion of unions as ‘spaces of dependence’ (Cox, 1998a, p.2), organisations whose space is centred upon realising essential interests. It also considers the quality of unions’ interactions with others – their ‘spaces of engagement‘(Cox, 1998a, p.2), and the impact that this has upon their ability to recruit youth. The findings reveal that most respondents across the spectrum of the union movement attribute the decline in youth membership levels to factors external to the movement itself, such as changes to industrial relations legislation and the impact of globalisation on employment markets. However, participants also attribute responsibility for declining membership levels to the union movement itself, citing factors such as a lack of resourcing and a need to change unions’ perceived identity and methods of operation. The research further determined that networks of connections across the union movement are tenuous and, to date, are not being fully utilised to assist unions to overcome the youth recruitment dilemma. The study concludes that potential connections between unions are hampered by poor resourcing, workload issues and some deeply entrenched attitudes related to unions ‘defending (and maintaining) their patch’.

Assessing cognitive development in early childhood : a comparison of the Bayley-III and the Stanford-Binet fifth edition

The Bayley Scales of Infant Development, Third Edition (Bayley-III) and Stanford-Binet Intelligence Scale, Fifth Edition (SB5) were administered in a sample of 26 typically developing children (12 males and 14 females) aged 24 – 42 months. Children completed the assessments in two separate sessions, counterbalanced for order of administration. Scores on the two instruments were not significantly related, with the exception of the SB5 Knowledge score, which was moderately correlated with the Language score on the Bayley-III (r = .41, p = 0.04). Despite no other significant correlations, for 22 of the 26 children, scores were very consistent across the two instruments. Implications for test selection are discussed.

Accumulation of recombinant cellobiohydrolase and endoglucanase in the leaves of mature transgenic sugar cane

A major strategic goal in making ethanol from lignocellulosic biomass a cost-competitive liquid transport fuel is to reduce the cost of production of cellulolytic enzymes that hydrolyse lignocellulosic substrates to fermentable sugars. Current production systems for these enzymes, namely microbes, are not economic. One way to substantially reduce production costs is to express cellulolytic enzymes in plants at levels that are high enough to hydrolyse lignocellulosic biomass. Sugar cane fibre (bagasse) is the most promising lignocellulosic feedstock for conversion to ethanol in the tropics and subtropics. Cellulolytic enzyme production in sugar cane will have a substantial impact on the economics of lignocellulosic ethanol production from bagasse. We therefore generated transgenic sugar cane accumulating three cellulolytic enzymes, fungal cellobiohydrolase I (CBH I), CBH II and bacterial endoglucanase (EG), in leaves using the maize PepC promoter as an alternative to maize Ubi1 for controlling transgene expression. Different subcellular targeting signals were shown to have a substantial impact on the accumulation of these enzymes; the CBHs and EG accumulated to higher levels when fused to a vacuolar-sorting determinant than to an endoplasmic reticulum-retention signal, while EG was produced in the largest amounts when fused to a chloroplast-targeting signal. These results are the first demonstration of the expression and accumulation of recombinant CBH I, CBH II and EG in sugar cane and represent a significant first step towards the optimization of cellulolytic enzyme expression in sugar cane for the economic production of lignocellulosic ethanol.

Using developmental theories to inform the design of technology for children

Electronic Blocks are a new programming environment, designed specifically for children aged between three and eight years. As such, the design of the Electronic Block environment is firmly based on principles of developmentally appropriate practices in early childhood education. The Electronic Blocks are physical, stackable blocks that include sensor blocks, action blocks and logic blocks. Evaluation of the Electronic Blocks with both preschool and primary school children shows that the blocks' ease of use and power of engagement have created a compelling tool for the introduction of meaningful technology education in an early childhood setting. The key to the effectiveness of the Electronic Blocks lies in an adherence to theories of development and learning throughout the Electronic Blocks design process.

Playing with picturebooks : postmodernism and the postmodernesque

This thesis traces the influence of postmodernism on picturebooks. Through a review of current scholarship on both postmodernism and postmodern literature it examines the multiple ways in which picturebooks have responded to the influence of postmodernism. The thesis is predominantly located in the field of Cultural and Literary Studies, which informs the ways in which children’s literature is positioned within contemporary culture and how it responds to the influences which shape its production and reception. Cultural and Literary Studies also offers a useful theoretical frame for analysing issues of textuality, ideology, and originality, as well as social and political comment in the focus texts. The thesis utilises the theoretical contributions by, in particular, Linda Hutcheon, Brian McHale, and Fredric Jameson as well as reference to children’s literature studies. This thesis makes a significant contribution to the development of an understanding of the place of the postmodern picturebook within the cultural context of postmodernism. It adds to the field of children’s literature research through an awareness of the (continuing) evolution of the postmodern picturebook particularly as the current scholarship on the postmodernism picturebook does not engage with the changing form and significance of the postmodern picturebook to the same extent as this thesis. This study is significant from a methodological perspective as it draws on a wide range of theoretical perspectives across literary studies, visual semiotics, philosophy, cultural studies, and history to develop a tripartite methodological framework that utilises the methods of postclassical narratology, semiotics, and metafictive strategies to carry out the textual analysis of the focus texts. The three analysis chapters examine twenty-two picturebooks in detail with respect to the ways in which the conventions of narrative are subverted and how dominant discourses are interrogated. Chapter 4: Subverting Narrative Processes includes analysis of narrative point of view, modes of representation, and characters and the problems of identity and subjectivity. Chapter 5: Challenging Truth, History, and Unity examines questions of ontology, the difficulties of representing history, and addresses issues of difference and ‘otherness’. The final textual analysis chapter, Chapter 6: Engaging with Postmodernity, critiques texts which engage with issues of globalisation, mass media, and consumerism. Brief discussion of a further fifteen picturebooks throughout the thesis provides additional support. Children’s texts have a tradition of being both resistant and compliant. Its resistance has made a space for the development of the postmodern picturebook; its compliance is evident in its tendency to take a route around a truly radical or iconoclastic position. This thesis posits that children’s postmodern picturebooks adopt what suits their form and purposes by drawing from and reflecting on some influences of postmodernism while disregarding those that seem irrelevant to its direction. Furthermore, the thesis identifies a shift in the focus of a number of postmodern picturebooks produced since the turn of the twenty-first century. This trend has seen a shift from texts which interrogate discourses of liberal humanism to those that engage with aspects of postmodernity. These texts, postmodernesque picturebooks, offer contradictory perspectives on aspects of society emanating from the rise in global trends mentioned above.

Observational assessment and maternal reports of motivation in children and adolescents with Down Syndrome

Despite a lack of consistent empirical evidence, there has been an ongoing assumption that intellectual disability is associated with reduced levels of motivation. The participants in this study were 33 children with Down syndrome ages 10–15 years and 33 typically developing 3–8-year-old children. Motivation was measured through observational assessments of curiosity, preference for challenge, and persistence, as well as maternal reports. There were no significant group differences on motivation tasks, but mothers of children with Down syndrome rated their children significantly lower on motivation than did parents of typically developing children. There were some intriguing group differences in the pattern of correlations among observations and parent reports. The findings challenge long-held views that individuals with intellectual disability are invariably deficient in motivation.

Lumia : Art | light | motion. The Art of Kuuki.

The State Library of Queensland is delighted to present Lumia: art/light/motion, a culmination of many years of collaboration by the Kuuki collective led by Priscilla Bracks and Gavin Sade. This extraordinary exhibition not only showcases the unique talent of these Queenslanders, it also opens up a world of future possibilities while re-presenting the past and present. These contemporary new media installations sit comfortably within the walls of the library as they are the distinctive products of inquisitive and philosophical minds. In a sense the exhibition highlights the longevity and purposefulness of a cultural learning institution, through the non-traditional use of data, information, research and collection interpretation. The exhibition simultaneously articulates one of our key objectives – to progress the state’s digital agenda. Two academic essays have been commissioned for this joint Kuuki and State Library of Queensland publication. The first is by artist and writer Paul Brown, who has specialised in art, science and technology since the late 1960s and in computational and generative art since the mid 1970s. Brown investigates the history of new media, which is celebrating its 60th anniversary, and clearly places Sade and Bracks at the forefront of this genre nationally. The second essay is by arts writer Linda Carroli, who has delved deeply into the thoughts and processes of the artists to bring to light the complex workings of the artists’ minds. The publication also features an interview Carroli conducted with the artists. This exhibition is playful, informative and contemplative. The audience is invited to play, and consequently to ponder the way we live and the environmental and social implications of our choices. The exhibition tempts us to travel deep into the Antarctic, plunge into the Great Barrier Reef, be swamped by an orchestra of crickets, enter the Charmed world and travel back in time to a Victorian parlour where you can interact with a ‘new-world’ lyrebird and consider a brave new world where our only link to the animal world is with robotic representations. In essence this exhibition is about ideas and knowledge and what better institution than the State Library of Queensland to partner such a project?. State Library is committed to preserving culture, exploring new media and creating new content as a lasting legacy of Queensland for all Queenslanders.

Drawing together as inclusive practice in early years learning

Contemporary critiques on early years education highlight a call for the need to implement teaching and learning strategies that are less managing, that emerge from equity and inclusivity agendas, and that recognise diversity and plurality in early years learning contexts. Such critiques raise a need to reconsider the ways we engage as adults with children, and to rethink how we might review these relational subjectivities in respect to teaching and learning. This paper focuses on some aspects of a pilot research study into collaborative drawing in order to discuss ideas about socially inclusive early childhood pedagogies.

Revisioning the self : self-portraiture as educator professional development

This paper focuses on a series of self-portraits I created between 2003 and 2009. Each portrait holds a series of layered images that the final layer conceals. As I created the self-portraits I also created written thinking in the form of a research journal. This a/r/tographic (Irwin & Springgay, 2008) research activity investigates the acquiring and accruing of visual art teaching knowledges and practices. I use as a premise, an opinion that the information acquired on an Education Degree slowly fades over time so, what is ‘information’ becomes ‘memory’. Memory is eventually what informs teaching, if further professional development is not undertaken.

Why a child needs a critical eye, and why the art classroom is central in developing it

It is a common acceptance that contemporary schoolchildren live in a world that is intensely visual and commercially motivated, where what is imagined and what is experienced intermingle. Because of this, contemporary education should encourage a child to make reference to, and connection with their ‘out-of-school’ life. The core critical underpinnings of curriculum based arts appreciation and theory hinge on educators and students taking a historical look at the ways artists have engaged with, and made comment upon, their contemporary societies. My article uses this premise to argue for the need to persist with pushing for critique of/through the visual, that it be delivered as an active process via the arts classroom rather than as visual literacy, here regarded as a more passive process for interpreting and understanding visual material. The article asserts that visual arts lessons are best placed to provide fully students with such critique because they help students to develop a ’critical eye’, an interpretive lens often used by artists to view, analyse and independently navigate and respond to contemporary society.